Pulmonary Vascular Disease

Question 1

Describe the PATHOGENESIS of PULMONARY EMBOLISM (PE):

Answer 1

1) Thrombus Forms in the Deep Veins of the Lower Limbs
2) Thrombus Embolises
3) Travels, Via the Venous System, Up to the Pulmonary Arteries
4) Occludes the Pulmonary Arteries

Question 2

What are the RISK FACTORS for VENOUS THROMBOEMBOLISM?

Answer 2

1) Recent Major Trauma
2) Recent Surgery
3) Cancer
4) Pregnancy
5) Inherited Thrombophilia
6) Significant Cardiopulmonary Disease, i.e. MI

Question 3

What are the SYMPTOMS of a PE?

Answer 3

1) Pleuritic Chest Pain
2) Cough
3) Haemoptysis
4) Isolated Acute Dyspnoea
5) Syncope

Question 4

What are the SIGNS of a PE?

Answer 4

1) Pyrexia
2) Stony Dullness to Percussion (Base of Lung)
3) Tachycardia
4) Tachypnoea
5) Hypotension
6) Hypoxia

Question 5

What are some of the INVESTIGATIONS used to DIAGNOSE a PE?

Answer 5

1) FBCs - Serum Biochemistry
2) ABGs
3) CXR
4) ECG
5) CT Pulmonary Angiogram (CT-PA)
6) V/Q Scan
7) Echocardiography
8) D-Dimer
9) Thrombophilia Testing

Question 6

How is a patient’s PROBABILITY of being affected by a PE ASSESSED?

Answer 6

Wells Score

Revised Geneva Score

Question 7

What are some of the TREATMENTS for a PE?

Answer 7

1) O2 Therapy
2) LMWH, i.e. Fondaparinux
3) Warfarin
4) Direct Oral Anticoagulants (DOAC), i.e. Rivaroxaban
5) Thrombolysis, i.e. Alteplase (rt-PA)
6) Pulmonary Embolectomy

Question 8

What is PULMONARY HYPERTENSION (PH)?

Answer 8

> BP in the Pulmonary Arteries/Tree

Mean Pulmonary Arterial Pressure > 25mmHg

Can be Primary or Secondary to other conditions

Question 9

What are some of the CAUSES of PH?

Answer 9

1) Idiopathic
2) Secondary to Chronic Respiratory Disorders
3) Secondary to Left Heart Disease
4) Chronic Thromboembolic PH (CTEPH)

Question 10

What are the SYMPTOMS of PH?

Answer 10

1) Exertional Dyspnoea
2) Chest Tightness/Pain
3) Exertional Presyncope/Syncope

Question 11

What are the SIGNS of PH?

Answer 11

1) Elevated JVP
2) Right Ventricular Heave
3) Loud Pulmonary 2nd Heart Sound
4) Hepatomegaly
5) Peripheral Oedema

Question 12

What INVESTIGATIONS would be used to DIAGNOSE PH?

Answer 12

1) ECG
2) Pulmonary Function Tests
3) CXR
4) Echocardiography
5) V/Q Scan
6) CT-PA
7) Right Heart Catheterisation

Question 13

What is the GENERAL TREATMENT for PH?

Answer 13

1) Treat Underlying Condition
2) O2 Therapy
3) Anticoagulation
4) Diuretics

Question 14

What are the SPECIFIC TREATMENTS for PH?

Answer 14

1) Calcium Channel Blockers, i.e. Amlodipine
2) Phosphodiesterase Inhibitors, i.e. Sildenafil
3) Prostacyclin
4) Endothelin Receptor Antagonists

Question 15

What are the OTHER TREATMENTS for PH?

Answer 15

Thromboendarterectomy

Lung or Heart-Lung Transplant